Study Links Diabetes Dx to Poor Prognosis

Shorter lives and with more disabilities

People with diabetes have a slightly shorter life expectancy than people without diabetes and, not surprisingly, many of those years will be marred by disability, according to an Australian study.

Researchers used a national cohort study of diabetes and found that, compared with people without diabetes, the estimated loss of life expectancy at age 50 was 3.2 (95% CI 3.0-3.4) years for men and 3.1 (95% CI 2.9-3.4) years for women. The estimated life expectancy was 30.2 years (95% CI 30.0-30.4) at age 50 for men, and the disability-free life expectancy -- which takes into account mortality levels and disability prevalence -- was 12.7 (95% CI 11.5-13.7).

For women, those estimates were 33.9 (95% CI 33.6-34.1) and 13.1 (95% CI 12.3-13.9) years respectively, according to lead author Lili Huo, MD, at Peking University in Beijing.

Huo and colleagues published their findings on Thursday in Diabetologia.

"The striking loss of disability-free life expectancy in diabetes reported in this study is likely to raise concern about the burden of diabetes in future decades, indicating a need to respond by implementing intervention and prevention of disability," wrote the authors.

The authors said that a recent study found a 50-80% increase in the odds of having a physical disability in diabetes patients versus nondiabetic patients. In this study, researchers found that risk of all diabetes-related disabilities, including severe disabilities, increased with age.

The authors further found that women with diabetes spent more years, both in absolute terms and in terms of proportion of their lives, with a disability compared with men with diabetes and to women without diabetes. In addition, if diabetes were to be eliminated in those patients, they would gain an extra 0.6 years (95% CI 0.5-0.6) in life expectancy and 1.8 years (95% CI 1.0-2.8) in disability-free life expectancy.

Data were drawn from an earlier Australian diabetes study. Mortality was determined by linking the data to Australia's National Death Index and diabetes patients were compared with the general population. Definitions of disability followed a framework and was defined as having at least one of 17 limitations.

The authors hypothesized that a number of factors are at play when it comes to decreasing disability-free life expectancy, including blood vessel complications, movement problems, and amputations.

Limitations of the study include reliance on only one framework for determining disability; the results may not be generalizable since definitions of disability vary widely. The authors relied on estimates that relied on the quality of the data being reported, and type 1 and type 2 diabetes were not separated in the analysis. In addition, the researchers could not account for those who have undiagnosed type 2 diabetes, and the results should not be used to predict life expectancy for individuals, the authors cautioned.

"Efforts to identify the specific causes of disability and effective interventions are needed," concluded Huo and colleagues.